Fixing Medicare

When ideas of healthcare reform began the question being asked was: Should we fix Medicare? With debates about the federal deficit swirling, the question has now become: How should we fix Medicare? The shift in positions and increase in urgency has come from the acknowledgement that Medicare is broken, and its costing the U.S. a ton of money.

It's easy to say we should fix Medicare; Actually figuring out how is a tad more difficult. As outlined in this New York Times article, President Obama's deficit reduction committee has considered a number of options. These options include (but are not limited to) :

1) Increasing the eligibility age for Medicare from 65 to 67
2) Requiring beneficiaries to pay higher premiums
3) Charging Co-payments for home health services
4) Paying doctors in "lump" amounts for entire treatments as opposed to paying for each step (tests, procedures) individually

The list goes on. For the complete range of options, check out the article. It's hard to say which option is best because all have pros and cons. For example, raising the eligibility age would save the government money for those two years, but those 65 and 66 year old patients might now be eligible for Medicaid. This just displaces the cost from Medicare to Medicaid.

Whichever solution is chosen, it will have to be supplemented with one thing: more efficient care. Changing the structure of Medicare will do nothing if health care is still administered in an inefficient way. This means, reducing medical errors, hospital infections, and administrative costs. More efficient care means cheaper care in the long run.

Fixing Medicare will probably require a pretty creative solution. What do you think is the best way to tackle this problem? Do you agree that any change needs to be supplemented with better health care? Will raising premiums do anything?

Lower Healthcare Spending with...A Checklist?

Health care spending is out of control for a number of reasons: the health insurance system, U.S. lifestyle, lack of preventive care, prescription drug costs, administrative costs etc. A cure-all solution for health care spending is near impossible. Atul Gawande has a solution that can make a difference and it doesn't involve a controversial bill or fancy new medial technology. It's as common as something you and I use every day: A Checklist.



In the video above, Atul Gawande, a surgeon at Bringham & Women's Hospital, explains his idea for a 19 point hospital checklist. His checklist is something surgeons, doctors and nurses can use to prevent mistakes, infections and deaths during hospital stays. His checklist was initially tested in 8 hospital worldwide. In these 8 hospitals there was a 1/3 reduction in infections and deaths during surgery. A hospital in Michigan implemented the checklist and saw a 2/3 reduction of infections, saved 1,500 lives and over 200 million dollars.

This checklist is being used in less than 1/4 of U.S. hospitals. Imagine if this was required by all hospitals? Hospital infections are negative externalities that cost the health care system a ton of money. A low cost solution like Atul's could save a lot of lives and money.

Are there other simple fixes like Atul Gawande's checklist that can contribute to lower health care spending? Can an idea as simple as a checklist really save lives and money?